From the Guidelines
Post-exposure prophylaxis (PEP) for HIV should be started as soon as possible after a potential exposure, ideally within 72 hours, and continued for 28 days, as recommended by the most recent guidelines 1. The recommended regimen is typically a three-drug combination of tenofovir disoproxil fumarate (TDF) 300mg plus emtricitabine (FTC) 200mg once daily, along with either dolutegravir 50mg once daily or raltegravir 400mg twice daily. Some key points to consider when administering PEP include:
- The exposure risk varies by type of contact, with needle-stick injuries, unprotected receptive anal intercourse, and exposure to blood or body fluids from HIV-positive individuals carrying higher risks 1.
- PEP is most effective when started immediately after exposure, with effectiveness decreasing significantly after 72 hours 1.
- After starting PEP, follow-up HIV testing is recommended at baseline, 4-6 weeks, and 3 months.
- Side effects may include nausea, fatigue, and headache, but these typically resolve with time.
- It's essential to take all medications as prescribed for the full 28 days to maximize effectiveness.
- PEP works by preventing HIV from establishing infection in the body by inhibiting viral replication during the early stages when the virus would otherwise be integrating into host cells. In cases where the source person's virus is known or suspected to be resistant to one or more of the drugs considered for the PEP regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended, and expert consultation is advised 1. For pregnant women or those with kidney problems, alternative medications may be used. Overall, prompt evaluation and initiation of PEP as soon as possible after exposure are crucial to prevent HIV infection 1.
From the Research
Post-Exposure Prophylaxis (PEP) for HIV
- PEP is an effective tool for preventing HIV transmission after high-risk exposure, and antiretroviral therapy (ART) has been recommended for PEP for over a decade 2, 3.
- The choice of antiretroviral drugs for PEP has evolved over time, with newer drugs offering improved safety and tolerability 4.
Safety and Efficacy of PEP Regimens
- A study evaluating a 3-drug PEP regimen consisting of raltegravir, tenofovir DF, and emtricitabine found that none of the 85 evaluable participants became HIV infected, and side effects were mild and self-limited 2.
- A systematic review of antiretroviral options for PEP found that tenofovir-based regimens had higher completion rates and lower discontinuation rates due to adverse events compared to zidovudine-based regimens 4.
- The review also found that the choice of third drug for PEP depends on the setting, with lopinavir/ritonavir being a reasonable choice for resource-limited settings 4.
Role of Healthcare Providers in PEP
- Healthcare providers, including nurse practitioners, play an essential role in managing treatment for people exposed to HIV and following up on their response and adherence to the treatment protocol 3.
- Understanding the life cycle of HIV is crucial for streamlining treatment regimens in exposed individuals, and healthcare providers should be aware of the latest clinical practice guidelines for PEP 3.